Acute Effect of Positive Expiratory Pressure Versus Breath Stacking Technique After Cardiac Surgery
- Conditions
- Complication, PostoperativeCardiac Complication
- Interventions
- Other: Breath StackingOther: Expiratory Positive Airway Pressure
- Registration Number
- NCT04013360
- Lead Sponsor
- Universidade Federal de Santa Maria
- Brief Summary
This study evaluates the efficacy and safety of a single session of positive expiratory pressure and of breath stacking technique in patients after cardiac surgery. The same patients will receive the two interventions, with an interval of 24 hours, and the acute effect of each will be verifed.
- Detailed Description
Physiotherapy uses techniques and equipment that reduce postoperative pulmonary complications. The technique called breath stacking consists of an instrumental feature composed of a unidirectional valve coupled to a face mask to promote the accumulation of successive inspiratory volumes. The technique is used to prevent atelectasis and improve gas exchange. Another therapy is called expiratory positive airway pressure (EPAP) that uses positive end expiratory pressure (PEEP) in spontaneously breathing patients, keeping the airway open during expiration. The EPAP system consists of a face mask, a one-way valve and the expiratory resistor, which is responsible for resistance to expiratory flow, which will determine the level of PEEP.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 24
Patients with indication for coronary artery bypass grafting and valve replacement, with surgical procedure for median sternotomy.
- incapacity to understand the Informed Consent Form.
- cognitive dysfunction that prevents the performance of evaluations or interventions,
- intolerance to the use of EPAP or BS mask
- with chronic obstructive pulmonary disease (COPD)
- cerebrovascular disease
- chronic-degenerative musculoskeletal disease
- chronic infectious disease
- in treatment with steroids, hormones or cancer chemotherapy
- hemodynamic complications (arrhythmia, myocardial infarction during the operation, with blood loss ≥ 20% of the total blood volume, defined by Mannuci, et al., 2007)
- mean arterial pressure <70 mmHg and reduced cardiac output, requiring the use of intra aortic balloon or vasoactive drugs
- tracheal intubation for more than 12 hours after admission to the ICU or reintubated
- individuals unable to maintain airway permeability.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Breath Stacking Breath Stacking Instrument composed of a one-way valve coupled to a face mask to promote the accumulation of successive inspiratory volumes. Breath Stacking Expiratory Positive Airway Pressure Instrument composed of a one-way valve coupled to a face mask to promote the accumulation of successive inspiratory volumes. Expiratory Positive Airway Pressure Breath Stacking Therapeutic technique consisting of a face mask, a one-way valve and an expiratory resistor, responsible for resistance to expiratory flow, which will determine the level of pressure in the airway. Expiratory Positive Airway Pressure Expiratory Positive Airway Pressure Therapeutic technique consisting of a face mask, a one-way valve and an expiratory resistor, responsible for resistance to expiratory flow, which will determine the level of pressure in the airway.
- Primary Outcome Measures
Name Time Method Tidal volume 12 to 24 hours after removal of drains and 24 hours after primary intervention It will be evaluated preoperatively and also before and after 10 minutes of each intervention, in the postoperative period. This measurement will be obtained through the the division of the minute volume by the respiratory rate.
Forced vital capacity (FVC) 12 to 24 hours after removal of drains and 24 hours after primary intervention It will be evaluated preoperatively and also before and after 10 minutes of each intervention, in the postoperative period, as recommended by the American Thoracic Society and European Respiratory Society (2006) and based on reproducibility and acceptability criteria, three maneuvers will be performed (variability \<5%) and considered the best curve for the study.
- Secondary Outcome Measures
Name Time Method Forced expiratory volume in the first second (FEV1) 12 to 24 hours after removal of drains and 24 hours after primary intervention It will be evaluated preoperatively and also before and after 10 minutes of each intervention, in the postoperative period, as recommended by the American Thoracic Society and European Respiratory Society (2006) and based on reproducibility and acceptability criteria, three maneuvers will be performed (variability \<5%) and considered the best curve for the study.
Peak expiratory flow (PEF) 12 to 24 hours after removal of drains and 24 hours after primary intervention It will be evaluated preoperatively and also before and after 10 minutes of each intervention, in the postoperative period, as recommended by the American Thoracic Society and European Respiratory Society (2006) and based on reproducibility and acceptability criteria, three maneuvers will be performed (variability \<5%) and considered the best curve for the study.
Forced expiratory flow between 25 and 75% of the curve of FVC (FEF25-75) 12 to 24 hours after removal of drains and 24 hours after primary intervention It will be evaluated preoperatively and also before and after 10 minutes of each intervention, in the postoperative period, as recommended by the American Thoracic Society and European Respiratory Society (2006) and based on reproducibility and acceptability criteria, three maneuvers will be performed (variability \<5%) and considered the best curve for the study.
Minute volume 12 to 24 hours after removal of drains and 24 hours after primary intervention It will be evaluated preoperatively and also before and after 10 minutes of each intervention. To obtain the Minute Volume (MV), the patient will be instructed to inhale and exhale slowly for one minute and the value of MV and respiratory rate (RR) will be recorded. The respiratory rate was measured by the movements of the rib cage during respiratory cycles performed in one minute. The MV will be obtained by a Wright ® ventilometer (British Oxigen Company, London, England).
Respiratory rate 12 to 24 hours after removal of drains and 24 hours after primary intervention They will be assessed at baseline, immediately after and 10 minutes after each intervention. The respiratory rate was measured by the movements of the rib cage during respiratory cycles performed in one minute.
Heart rate 12 to 24 hours after removal of drains and 24 hours after primary intervention They will be assessed at baseline, immediately after and 10 minutes after each intervention, through multi-parameter monitor.
Peripheral Oxygen Saturation (SpO2) 12 to 24 hours after removal of drains and 24 hours after primary intervention They will be assessed at baseline, immediately after and 10 minutes after each intervention through the G-Tech® portable pulse oximeter.
Blood pressure 12 to 24 hours after removal of drains and 24 hours after primary intervention They will be assessed at baseline, immediately after and 10 minutes after each intervention. The blood pressure will be obtained through multi-parameter monitor.
Heart work measurement 12 to 24 hours after removal of drains and 24 hours after primary intervention They will be assessed at baseline, immediately after and 10 minutes after each intervention through the calculation of the double product (multiplication of systolic blood pressure by heart rate).
Thoracoabdominal mobility 12 to 24 hours after removal of drains and 24 hours after primary intervention Will be evaluated by thoracic and abdominal cirtometry
Painful perception in the surgical incision 12 to 24 hours after removal of drains and 24 hours after primary intervention Will be assessed at baseline, immediately after and 10 minutes after each intervention through a Visual Analog Scale, a one-dimensional instrument for evaluation of pain intensity, with a range of 1 to 10.
Degree of dyspnea 12 to 24 hours after removal of drains and 24 hours after primary intervention Will be assessed at baseline, immediately after and 10 minutes after each intervention, through the Modified Borg Scale, a vertical scale quantified from 0 to 10. Zero represents no symptoms and 10 represents maximum symptoms.
Signs of respiratory discomfort (dizziness, tachypnea, sweating, use accessory musculature) 12 to 24 hours after removal of drains and 24 hours after primary intervention They will be assessed at baseline, immediately after and 10 minutes after each intervention, through clinical inspection.
Trial Locations
- Locations (1)
Federal University of Santa Maria
🇧🇷Santa Maria, Rio Grande Do Sul, Brazil